Provider Demographics
NPI:1407948938
Name:HOMESTEAD NURSING CENTER, LLC
Entity Type:Organization
Organization Name:HOMESTEAD NURSING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-272-6682
Mailing Address - Street 1:1608 VERSAILLES ROAD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2402
Mailing Address - Country:US
Mailing Address - Phone:859-252-0871
Mailing Address - Fax:859-389-9571
Practice Address - Street 1:1608 VERSAILLES ROAD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2402
Practice Address - Country:US
Practice Address - Phone:859-252-0871
Practice Address - Fax:859-389-9571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100108314000000X, 332B00000X, 332BP3500X, 335E00000X
332BN1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12501003Medicaid
KY00000054847OtherANTHEM BC/BS
KY185144Medicare ID - Type Unspecified
KY0530120002Medicare NSC